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Full Crossmatch for all Crossmatch Requests


Dan87
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It was the early '90s when I first went to immediate spin crossmatches.  In '96 I went to a new facility and my first order of business there was to move them to immediate spin crossmatches. I met with a fair amount of resistance initially but supplied the supporting documentation to the transfusion Medical Director.  We were the first in that state wide corporation to do so.  Much to every one else's surprise our patients did not start dying right and left from transfusion reactions.  The one thing I did do to make the transfusion service medical director more comfortable was to switch from a 2 cell antibody screen to a 3 cell screen.  There is a great deal of documentation supporting both the IS crossmatch and the electronic/computer crossmatch (sorry Malcolm).  I know John Judd and his group at the University of Michigan were among the first and you should be able to find their papers in issues of Transfusion from the '80s if you are interested.  

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.....among few, one of the reason cited by our BB leadership for not switching into IS or electronic XM was our patient population. Most of our patient are Sickle cell patients who get chronically transfused and leadership are right to some extent as we have been able to detect rare/weird antibodies during our full XM.

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13 hours ago, Dan87 said:

.....among few, one of the reason cited by our BB leadership for not switching into IS or electronic XM was our patient population. Most of our patient are Sickle cell patients who get chronically transfused and leadership are right to some extent as we have been able to detect rare/weird antibodies during our full XM.

Would be interested to see some of these findings published.

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We started using IS crossmatch in the 90's. (I was one of those techs that thought we would kill everyone. I was scared!!) We switched to 3 cell screening cells at the same time. Once I realized I was not killing people, it was great!

We went to electronic crossmatch in 2007 when we switched to a computer system that could handle it. I was scared again and didn't fully embrace it for a week. Once I realized people weren't being carried out due to the crossmatch I was performing, I never looked back. It has made our work so much easier! 

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By "full" crossmatch are we talking doing it through AHG here?  We have never done that here for all patients and I have been around since 1988.  

Does anyone really still do this?  In an era where everyone is switching to electronic crossmatches for most patients?

Scott

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31 minutes ago, SMILLER said:

By "full" crossmatch are we talking doing it through AHG here?  We have never done that here for all patients and I have been around since 1988.  

Does anyone really still do this?  In an era where everyone is switching to electronic crossmatches for most patients?

Scott

Way more than you'd think Scott. There's plenty of resistance to change in our industry. I inspected a transfusion service where the entire hospital was on EMR, the laboratory had an LIS, but the blood bank supervisor had won their case to keep blood bank computer-less. They also did all IAT crossmatches. Interestingly enough, most of the techs weren't even aware that you could opt for IS crossmatches, leading me to believe that most other hospitals in that region were doing something similar.

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3 hours ago, cswickard said:

Well, you can see the reasoning with patients with rare, weird antibodies that never show up on even a 3 cell screen.  Match your practices to the needs of your patients - it isn't a one practice fits all kind of service we do.

I understand from where you are coming cswickard (I really do), but in such cases, the rare, weird antibodies that will never show up even on a three cell screen really are rare, because anti-U, anti-Jsb, anti-Fy3, anti-hrB and anti-hrS will all be detected, and I would suggest that, under the circumstances, a Js(a+) red cell should be included in the three cell screen.

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18 hours ago, Dan87 said:

.....among few, one of the reason cited by our BB leadership for not switching into IS or electronic XM was our patient population. Most of our patient are Sickle cell patients who get chronically transfused and leadership are right to some extent as we have been able to detect rare/weird antibodies during our full XM.

Would be very interested to know what antibodies were detected.

Edited by R1R2
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On ‎3‎/‎13‎/‎2017 at 8:56 AM, goodchild said:

Way more than you'd think Scott. There's plenty of resistance to change in our industry. I inspected a transfusion service where the entire hospital was on EMR, the laboratory had an LIS, but the blood bank supervisor had won their case to keep blood bank computer-less. They also did all IAT crossmatches. Interestingly enough, most of the techs weren't even aware that you could opt for IS crossmatches, leading me to believe that most other hospitals in that region were doing something similar.

Amazing!  Just amazing!  And not in a good way.

Edited by R1R2
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31 minutes ago, goodchild said:

I just remembered what else I saw at that hospital! (I was racking my brain yesterday trying to coax out the memory.) They also did autocontrols with every antibody screen and were using albumin as their routine enhancement medium.

Good Lord!!!!!!!!!

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1 hour ago, Dan87 said:

While I have personally identified antibodies like Kpa, Jsa, V, Cw; our facility have identified antibodies like anti-scianna, anti-Wr(a), anti-henshaw, anti-Do(a), VS.

Scianna antibodies, Wr(a) and henshaw are the antibodies I have never heard before.

Congratulations on finding that little lot - very impressive!

The Scianna Blood Group System is the 13th in the ISBT numerical system.  When I started out in this game, there were only three antigens in the System (Bua, Sm and Sc3), but things have changed!  Sm, a high prevalence antigen, has been renamed Sc1.  Bua, a low prevalence antithetical antigen to Sc1, has been renamed Sc2.  Sc3 was expressed on all red cells apart from those of the very rare null phenotype.  In addition, Rd, STAR, SCER and SCAN have been added to the System (Rd being low prevalence, and the three others high incidence).

Wra was originally called the Wright antigen, and is a low prevalence antigen antithetical to the high prevalence antigen Wrb.  These two antigens have now joined the Diego Blood Group System as Di3 and Di4 respectively.Wr(a+) red cells are very rare, but anti-Wra, which seems to be made with no apparent red cell stimulus (what used to be called "naturally occurring) is actually quite common.

He is antithetical to the 'N' antigen (NOTE - not the N antigen) within the MNS Blood Group System - N is expressed on glycophorin A, whereas 'N' is expressed on glycophorin B.  Sadly, it is not as simple as that.  About 23% of S-s- red cells are He+, but the He antigen is not a "single entity", but a "collection of antigens" that come about as a result of different variant glycophorins.

I hope that helps a bit, rather than "muddying the waters" further.

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Before switching to immediate spin crossmatch from AHG crossmatch on everyone, we would find many of those antibodies, that you mentioned, Dan87.  We did not blink when we switched to immediate spin (and then electronic (sorry Malcolm) crossmatch).   We are a large urban hospital system with many sicklers.   We knew that we would miss the occasional low freq ab that could not be detected on the screening cells.  (One note, many of our sicklers require full AHG crossmatch due to history of clinically significant antibody, but they would get IS XM if they qualified)   I have not seen one incident of a HTR due to the antibodies you mentioned.   I am sure that they occur, but rarely, and not a reason to stick with AHG XM for all, IMO.     One document that I love to review is the FDA report on fatalities due to transfusion.   It is always a good read.   https://www.fda.gov/BiologicsBloodVaccines/SafetyAvailability/ReportaProblem/TransfusionDonationFatalities/

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16 minutes ago, R1R2 said:

Before switching to immediate spin crossmatch from AHG crossmatch on everyone, we would find many of those antibodies, that you mentioned, Dan87.  

I agree that almost all of them are considered to be either clinically insignificant or, at best, of dubious clinical significance.  The only couple of which I may take notice, and that would depend upon the strength of the reactions, would be anti-Jsa and the anti-Doa.

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